A couple of points: If you go to the main MERS page, you'll see nothing for week 34. Perhaps this means no cases were reported that week, but even that would have been useful information. Also, note the "event numbers": 18-1741, 18-1742 (the Buraidah case is listed as 01 September New 18-1743, though it doesn't show up in what I've excerpted). Does this mean Saudi Arabia has seen 1,743 MERS cases so far this year? I have no idea.

The Epidemiological Situation of Ebola Virus Disease on August 31, 2018:

• A total of 120 cases of haemorrhagic fever were reported in the region, 90 confirmed and 30 probable.

• 11 suspected cases are under investigation.

• 2 new confirmed cases in Beni.

• 1 confirmed case death in Mabalako.

Remarks:

• To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table.

• The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not.

News of the response

Distribution of cases by age and sex of the epidemic to Ebola Virus Disease in North Kivu Province

This graph reveals that:

• Women have been more affected than men by this tenth outbreak of Ebola Virus Disease;

• For men, the most affected age group is 35-44;

• Among women, the most affected age group is 25 to 34

Vaccination

• Since the beginning of vaccination on August 8, 2018, 5,462 people have been vaccinated , including 2,852 in Mabalako, 1,433 in Beni, 1,037 in Mandima, 121 in Oicha and 19 in Kinshasa.

Mass campaigns with oral poliovirus vaccine (OPV) have brought the world close to the eradication of wild poliovirus. However, to complete eradication, OPV must itself be withdrawn to prevent outbreaks of vaccine-derived poliovirus (VDPV). Synchronized global withdrawal of OPV began with serotype 2 OPV (OPV2) in April 2016, which presented the first test of the feasibility of eradicating all polioviruses.

METHODS

We analyzed global surveillance data on the detection of serotype 2 Sabin vaccine (Sabin-2) poliovirus and serotype 2 vaccine–derived poliovirus (VDPV2, defined as vaccine strains that are at least 0.6% divergent from Sabin-2 poliovirus in the viral protein 1 genomic region) in stool samples from 495,035 children with acute flaccid paralysis in 118 countries and in 8528 sewage samples from four countries at high risk for transmission; the samples were collected from January 1, 2013, through July 11, 2018. We used Bayesian spatiotemporal smoothing and logistic regression to identify and map risk factors for persistent detection of Sabin-2 poliovirus and VDPV2.

RESULTS

The prevalence of Sabin-2 poliovirus in stool samples declined from 3.9% (95% confidence interval [CI], 3.5 to 4.3) at the time of OPV2 withdrawal to 0.2% (95% CI, 0.1 to 2.7) at 2 months after withdrawal, and the detection rate in sewage samples declined from 71.0% (95% CI, 61.0 to 80.0) to 13.0% (95% CI, 8.0 to 20.0) during the same period. However, 12 months after OPV2 withdrawal, Sabin-2 poliovirus continued to be detected in stool samples (<0.1%; 95% CI, <0.1 to 0.1) and sewage samples (8.0%; 95% CI, 5.0 to 13.0) because of the use of OPV2 in response to VDPV2 outbreaks. Nine outbreaks were reported after OPV2 withdrawal and were associated with low coverage of routine immunization (odds ratio, 1.64 [95% CI, 1.14 to 2.54] per 10% absolute decrease) and low levels of population immunity (odds ratio, 2.60 [95% CI, 1.35 to 5.59] per 10% absolute decrease) within affected countries.

CONCLUSIONS

High population immunity has facilitated the decline in the prevalence of Sabin-2 poliovirus after OPV2 withdrawal and restricted the circulation of VDPV2 to areas known to be at high risk for transmission. The prevention of VDPV2 outbreaks in these known areas before the accumulation of substantial cohorts of children susceptible to type 2 poliovirus remains a high priority.

A total of 554 cholera patients were treated between May 28 and August 19 in Baraka (South Kivu), an average of 46 cases per week for 11 weeks, reports Médecins Sans Frontières (MSF).

According to the organization's calculations, this represents nearly 70% of cholera cases reported in the province by the Provincial Health Division (DPS) of South Kivu over this period, which is the second most affected by cholera in the country since the beginning of the year, just behind Kasai Oriental.

Three months after the beginning of the epidemic, the response to prevent and stop the spread of the disease in and around Baraka remains largely inadequate and the affected population still does not have sufficient drinking water. In addition, the mobilization of the actors and resources they need to coordinate and respond to this emergency is laborious, alert MSF supports in particular the Cholera Treatment Center in Baraka.

"Beyond the medical care of patients affected by cholera, provided by the BCZ with the support of MSF and thanks to which we have been able so far to avoid deaths in the CTC, it is urgent that the response to the epidemic is improving in terms of access to drinking water, notably through the establishment of chlorination points and health promotion activities," says Fernando Galvan, MSF Head of Mission in the South Kivu.

"Measures to strengthen hygiene and sanitation in the area are one facet of the response to the epidemic, which must not only be curative but also seek to prevent transmission and spread," he added.

MSF is worried about the possible consequences of this lack of response, as this situation is likely to continue to deteriorate and impact the surrounding health zones.

The African Union has deployed 35 experts from different fields in the DRC to fight alongside the Congolese government against Ebola virus disease in North Kivu and Ituri. In addition to logistics, training and awareness, the AU, through its "Africa CDC" structure, recruits and sends field experts, said Thursday, Aug. 30 Donewell Bangure, epidemiologist at Africa CDC.

"Currently we have deployed 35 experts, epidemiologists, anthropologists, laboratory experts and communication experts. We deploy these experts based on field needs. And also according to the evolution of the epidemic on the ground. Currently, we are ready to mobilize the necessary resources that are already ready so that if necessary, we continue to deploy personnel to ensure this response," said Donewell Bangure.

He said that they are experts recruited in the DRC and with whom the AU once worked in Mbandaka and who were effective.

The Centre for Health Protection (CHP) of the Department of Health today (August 31) reported the latest number of cases of dengue fever (DF), and again urged the public to maintain strict environmental hygiene, mosquito control and personal protective measures both locally and during travel.

From August 25 to 31 (as of noon), the CHP recorded one imported DF case. The patient had been to multiple countries (Maldives, Malaysia and Japan) during the incubation period.

As of noon today (August 31), 90 cases had been confirmed this year, 28 of which were local cases and 62 imported cases. The imported cases were mainly imported from Thailand (26), the Philippines (12) and Cambodia (seven).

DF remains endemic in some areas in Asia and beyond. In Guangdong, there were 121 cases recorded in the first seven months of this year. The latest figures for 2018 reveal that 50 079 cases have been recorded in Thailand, 1 846 in Singapore (since December 31, 2017) and 90 in Japan. In Taiwan, 55 local cases have been recorded to date in 2018. In the Americas, the latest figures indicate that 239 389 and 23 211 cases have been filed in Brazil and Mexico respectively in 2018.

August 31, 2018

Health workers fighting the ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC) have given nearly 20 people experimental drugs to treat the virus since mid-August. But because the drugs have been dispensed on a case-by-case, ‘compassionate use’ basis, it is hard to know whether any are effective. Now, desperate to determine which therapy works best, researchers from the DRC and US governments, the World Health Organization and other groups are meeting this week to plan a clinical trial that will compare multiple drugs as the outbreak continues.

For ethical reasons, the trial scientists say they do not intend to give any study participants a placebo. Instead, they hope to compare the two experimental medicines now in use to ZMapp, an antibody therapy that showed promise in limited tests three years ago during a major Ebola epidemic in West Africa. Patients in the coming trial would receive one of these three drugs at random. The study design draws on a flexible clinical-trial framework that the WHO expects to unveil early next week. The framework is intended for use in multiple Ebola outbreaks, to produce data that can be pooled over time.

The scientists working on the DRC trial hope to launch the effort in the coming weeks. “A clinical trial will give us the scientific evidence we need,” says Jean-Jacques Muyembe-Tamfum, director-general of the National Institute for Biomedical Research in Kinshasa, which will lead the study.

But planning for the trial is complicated by the realities of working in a conflict zone: the DRC’s North Kivu and Ituri provinces, where fighting has killed more than 5 million people over the past two decades. Instability in the region could prevent clinicians from giving patients repeated infusions of drugs and collecting the biochemical data that a trial would require. “We can’t control what happens around a treatment centre,” Muyembe-Tamfum says. “Armed groups can do what they want.”

Moving quickly

The current outbreak began on 1 August, and has grown to include 115 confirmed and probable cases of Ebola — including 77 people who have died, the DRC health ministry said on 28 August. Public-health workers have vaccinated 4,645 people, and doctors have given 3 people the antiviral drug remdesivir, made by Gilead Sciences of Foster City, California. Another 13 patients have received mAb114, an experimental treatment derived from antibodies found in the blood of a person who contracted Ebola in 1995 and survived.

That swift response is a major shift from the handling of the Ebola epidemic that struck West Africa in 2014. Experimental drugs were not used widely in West Africa then because there was no proof of their safety or efficacy — clinical trials did not begun until the outbreak was near its end. That delay helped to drive the death rate among Africans infected with Ebola to 63%. But several Westerners infected with Ebola received the nascent therapies in top hospitals; the fatality rate for this group of patients was just 18%2. The controversy over this disparity eventually prompted the WHO to develop guidelines aimed at ensuring wider access to experimental treatments during future Ebola outbreaks.

But the only way to determine how well a drug works — and to rule out confounding factors, such as overall quality of medical care — is through a randomized, controlled clinical trial. Thus far, researchers have not managed to complete a trial of any experimental Ebola drug, because outbreaks of the disease have ended before enough patients enrolled in the studies. So the WHO has been working with international experts to create a basic trial design that can be adapted as data accumulate and logistical challenges change.

Note the statistic buried in the fourth paragraph: "fighting has killed more than 5 million people over the last two decades" in North Kivu and Ituri provinces. Presumably this slaughter has gone unnoticed in the Western media because the region offers little or nothing of strategic value to Western nations.

Yet we see no dramatic international action to suppress the violence that's a far, far greater threat to public health than Ebola will ever be.

The epidemiological situation of the Ebola Virus Disease dated 30 August 2018:

• A total of 118 cases of haemorrhagic fever were reported in the region, 88 confirmed and 30 probable.

• 13 suspected cases are under investigation.

• 2 new confirmed cases in Beni.

• No new deaths.

Remarks:

• To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table.

The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not.

News of the response

Day of Traditional Medicine

• This Friday, August 31, 2018, African countries celebrated the Day of Traditional Medicine. Traditional medicine practiced by traditional healers remains particularly popular with the Congolese population, especially in rural areas. In many areas, traditional healers are the primary providers of primary care because people first go to their homes before seeing a conventional doctor at a health center. This is an important factor to consider in the context of an Ebola outbreak. Therefore, sensitization and involvement of traditional healers in the response is essential. It is for this reason that the Social Mobilization Commission organized today a briefing with the traditional healers of Beni. During this briefing,

Vaccination

• Since the start of vaccination on 8 August 2018, 5,150 people have been vaccinated , including 2,707 in Mabalako, 1,286 in Beni, 1,017 in Mandima, 121 in Oicha and 19 in Kinshasa.

The Ministry of Health on Thursday, August 30, 2018, the heads of neighborhoods of the city of Beni (North Kivu) mobile phones as part of the response to the Ebola virus disease.

A total of 30 neighborhood leaders who benefited from this allocation to alert health officials about possible suspected cases.

"The grassroots authorities are our real partners in the response. We gave them the phones so they can alert us whenever there is an alert or suspicion. They are the guardians of the community, they each received a phone to raise awareness and especially report suspicious cases," said Dr. Oly Ilunga, Minister of Health.

Neighborhood leaders also visited the Ebola Treatment Center (ETC) built at the Beni Reference General Hospital where patients are being cared for.

The epidemic has already killed about thirty people. Since vaccination began on August 8, 2018, 4,645 people have been vaccinated, including 2,372 in Mabalako, 1,135 in Beni, 1,017 in Mandima and 121 in Oicha.

A total of 115 cases of haemorrhagic fever were reported in the region, of which 85 were confirmed and 30 were probable.

The outbreak of Ebola virus disease (EVD) in the Democratic Republic of the Congo is at a key juncture. Recent trends (Figure 1) suggest that control measures are working. Over the past week, contact follow-up rates have substantially improved, most patients recently admitted to Ebola treatment centres (ETC) received therapeutics within hours of being confirmed, and ring vaccination activities have scaled to reach contacts (and their contacts) of most confirmed cases reported in the last three weeks.

However, the outbreak trend must be interpreted with caution. Since the last Disease Outbreak News on 24 August 2018, 13 additional confirmed and probable cases have been reported, the majority (n=8) were from the city of Beni. Moreover, substantial risks remain, posed by potential undocumented chains of transmission; four of the 13 new cases were not known contacts.

Likewise, sporadic instances of high-risk behaviours in some communities (such as unsafe burials, reluctance towards contact tracing, vaccination and admission to ETCs if symptoms developed), poor infection prevention and control (IPC) practices in some community health centres, and delays in patients reaching ETCs when symptoms develop, all have the potential to further propagate the outbreak.

As of 29 August 2018, a total of 116 EVD cases (86 confirmed and 30 probable) including 77 deaths (47 confirmed and 30 probable)1 have been reported in five health zones in North Kivu (Beni, Butembo, Oicha, Mabalako, Musienene) and one health zone in Ituri (Mandima). Eight suspected cases from Mabalako (n=5) and Beni (n=3) are currently pending laboratory testing to confirm or exclude EVD. The majority of cases (65 confirmed and 21 probable) have been reported from Mabalako Health Zone (Figure 2). The median age of confirmed and probable cases is 35 years (interquartile range 19–45.5 years), and 56% were female (Figure 3).

Credit: WHO

Fifteen cases have been reported among health workers, of which 14 were laboratory confirmed; one has died. All health worker exposures likely occurred in health facilities outside of the dedicated ETCs. WHO and partners continue to work with health workers and communities to increase awareness on IPC measures, as well as vaccinate those at risk of infection.

In addition to the ongoing response activities within outbreak affected areas, the MoH, WHO and partners will be implementing a 30-day strategic plan to ensure operational readiness measures against EVD are strengthened in all provinces of the Democratic Republic of the Congo. The first phase of implementation will prioritise six provinces at highest risk of case importations: South Kivu, Maniema, Ituri, Tanganika, Haut Uele and Bas Uele. The main objective is to ensure that these provinces implement essential operational readiness measures, including enhancing surveillance, IPC and social mobilization to mitigate, rapidly detect, investigate and effectively respond to a possible outbreak of EVD.